Order Guide: PSA Testing
Prostate-Specific Antigen (PSA) is a blood test that looks for a protein that is produced in the prostate gland. PSA levels are a marker of prostate size but can also be used to determine if someone has prostate cancer
- A screening PSA level is completed when a man has no prostate symptoms.
- A diagnostic PSA level is completed when a man has prostate symptoms.
- Getting up at nighttime to urinate
- Straining to urinate
- Starting and stopping when urinating
- Having a slow or weak urinary stream
- Having an urgency to urinate
- Having to urinate frequency
BPH is the natural enlargement of the prostate that occurs in all men as they age. Having an enlarged prostate doesn’t mean one has prostate cancer, but it can produce the same symptoms as prostate cancer.
- The Canadian Task for Preventative Health strongly recommends AGAINST screening for prostate cancer with a PSA test in men younger than 55 and older than 70.
- There is a benefit for men between 55 to 69 being screened, though the benefit is very small. Approximately 1 in 1000 men screened will avoid prostate cancer death due to screening.
- There is a risk of false positives that can lead to unnecessary anxiety, repeat testing and unnecessary surgical procedures. For example, a quoted statistic is that of 1000 men screened with a PSA level, 178 men will have a positive PSA test where there is no prostate cancer (i.e. they have an enlarged prostate).
- 4 of these 178 men will end up with complications from a biopsy including infection and/or bleeding resulting in hospitalization.
- African American ancestry
- Having a father or brother with prostate cancer before age 65
- Have a genetic risk factor, like the BRCA mutation in your family
- Your symptoms are new and came on suddenly.
- You have fevers or are unwell.
- You cannot urinate.
- You are incontinent (cannot control your bladder)
- You have blood in your urine.
- Urinary retention is when the lower urinary tract becomes obstructed by an enlarged prostate, causing urine to back up in the urinary system. This can cause permanent damage to the kidney and is life-threatening. If you are unable to urinate or become incontinent of urine, we recommend an immediate visit to an urgent care centre.
Canadian Urological Guidelines recommend referral in the following circumstances:
- Recurrent or refractory urinary retention
- Recurrent urinary tract infections (UTIs)
- Bladder stones
- Blood in your urine
- Kidney damage determined by physician review of your eGFR (kidney function blood test)
- You would like to see a specialist
We recommend a digital rectal exam annually if you have prostate symptoms, or sooner if there is a change in your symptoms.
- Restrict fluid before bedtime
- Avoid caffeinated beverages, alcohol and spicy foods
- Bladder Training
- Pelvic Floor Exercises
- Ensure you are not constipated
- Avoid some medications (i.e. decongestants, antihistamines, diuretics, etc)
What is my prostate score?
The International Prostate Symptom Score (IPSS) - found here: https://qxmd.com/calculate/calculator_338/international-prostate-symptom-score-ipss is a validated tool used to assess the severity of your prostate symptoms.
- Mild symptoms = IPSS < 7
- Bothersome moderate = IPSS 8-18
- Severe = IPSS 19-35
 Nickel, J. C., Aaron, L., Barkin, J., Elterman, D., Nachabé, M., & Zorn, K. C. (2018). Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 12(10), 303–312. https://doi.org/10.5489/cuaj.5616